OCCUPATIONAL HEALTH ADVISORY Workplace Health and Public Safety Programme Health Canada Interim Occupational Health Advice May 1, 2009 SUBJECT: H1N1 FLU VIRUS (HUMAN SWINE INFLUENZA)/SEVERE RESPIRATORY INFECTION This guidance document is being provided by Health Canada in response to the recent outbreak of H1N1 Flu Virus (Human Swine Influenza) in North America. This guidance has been developed to assist federal employees whose work places them at higher risk for developing H1N1 Flu Virus (Human Swine Influenza). This guidance is based on current available scientific evidence about this emerging disease, and is subject to review and change as new information becomes available. INTRODUCTION: H1N1 Flu Virus (Human Swine Influenza) is caused by a novel virus with the ability to spread person to person. H1N1 Flu Virus (Human Swine Influenza) has been reported in Canada, Mexico, United States and a number of other countries. The Public Health Agency of Canada (PHAC) is working collaboratively with Mexican, American and World Health Organization officials to further investigate this situation. Health Canada’s Workplace Health and Public Safety Programme (WHPSP) is providing federal departments with this health advisory to assist you in addressing questions and concerns about the current situation and to advise and support you in protecting your employees, particularly those who may be at higher risk of infection. The content of this document is largely based on the general recommendations included in the Canadian Pandemic Influenza Plan for the Health Sector. It is expected that this occupational health guidance may change as further information about the epidemiology (e.g., mode transmission) and clinical course (e.g., mild or severe disease) of this novel virus is available.
2009-05-08 ASSUMPTIONS The following are assumptions, based on current available scientific evidence, used to make recommendations in this document: • The symptoms of H1N1 Flu Virus (Human Swine Influenza) in people are similar to the
symptoms of seasonal influenza (Influenza-like illness or ILI) and include fever, cough, sore throat, runny nose, general body aches. (Note: in children under 5, gastrointestinal symptoms may also be present.) In people under age 5 or 65 and older, fever may not be prominent.
• Like seasonal influenza, H1N1 Flu Virus (Human Swine Influenza) can vary in severity from
• The more severe cases, including deaths, have mostly occurred in Mexico.• Human-to-human transmission of H1N1 Flu Virus (Human Swine Influenza) is occurring.• Human-to-human transmission of H1N1 Flu Virus (Human Swine Influenza) occurs in the
same way as seasonal influenza, i.e. mainly through coughing or sneezing by infected people.
• The seasonal influenza vaccine is unlikely to provide protection against H1N1 Flu Virus
• H1N1 Flu Virus (Human Swine Influenza) virus is sensitive to Oseltamivir and Zanamivir.• H1N1 Flu Virus (Human Swine Influenza) virus is resistant to amantadine and rimantidine.• People with H1N1 Flu Virus (Human Swine Influenza) are infectious for up to 7 days
• Transmission is possible while asymptomatic but it is more efficient when symptoms such as
coughing, are present and viral shedding is high (i.e. early in symptomatic period).
RECOMMENDATIONS: A. GENERAL RECOMMENDATIONS FOR ALL EMPLOYEES

Most federal employees are not at greater risk than the general public and should follow public health advisories. Recommendations:Cover your Mouth and nose when you cough and sneeze

If possible, cover your mouth and nose with tissue when you cough or sneeze; put used tissue in the wastebasket. If you have no access to tissue, if you cough or sneeze, cover your mouth and nose with your arm. Clean your hands after coughing or sneezing.
2009-05-08 Clean your hands often All employees should regularly wash hands for 15-20 seconds with soap and water or use an alcohol based hand rub (60-90%) if hands are not visibly soiled. Hand washing is the best method of preventing the spread of infectious disease.

Avoid touching your eyes, nose or mouth unnecessarily. When sick, or if you have influenza symptoms, stay home, get plenty of rest and contact your health care provider as needed. Appointments with clients or colleagues who have a respiratory illness should be rescheduled.

As we learn more about the situation, we will update our recommendations B.RECOMMENDATIONS FOR EMPLOYEES WITH HIGHER RISK OF EXPOSURE Federal Health Service workers who have direct/hands-on patient care, such as CSC or FINIH nurses are referred to the Public Health Agency of Canada (PHAC) guidelines for health service workers referenced below. http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/pdf/interim_guidance_infection_control-eng.pdf http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/hp-ps-info_amb-eng.php For those federal employees whose work or job duties may put them at increased risk (e.g. Port of Entry Officers such as CBSA, CFIA, and EC Canadian Wildlife Service at ports of entry, and Quarantine Officers), you are advised to follow the general recommendations set out above as well as the following specific recommendations in this advisory. Both sets of recommendations are similar to the advice given previously to all Port of Entry Officers who must deal with migrant travelers (particularly those coming from Mexico at this time) of unknown health status who present with severe illness and/or symptoms of serious respiratory illness or appear to be ill (e.g. fever, chills, severe cough, respiratory distress). The specific recommendations are as follows:
• Maintain a distance of two meters from the person who is ill. Frequent hand washing is
important, especially after handling documents from an ill person. Wash hands with soap and water. If running water is not easily available and hands are not visibly soiled, use alcohol-based hand rub. You should avoid touching your face, mouth, nose and eyes with unwashed or gloved hands.
• Have the ill person don (wear) a surgical mask. If they are unable to do this, have them
cough into a tissue or cover their mouth and nose with the inside of their elbow.
• Place ill person in an area or room away from others.
• Call Quarantine Officer or Quarantine Service to assess ill travelers, if needed. .A
Quarantine Officer can be reached by calling the relevant Quarantine Station (see list attached), or by calling the 24/7 Public Health Agency of Canada (PHAC) Duty Officer at 1-800-545-7661
• If needed, call Ambulance or First Responders.
• If you are required to spend time in close contact (less than two meters away) with the ill
person (e.g. in a separate room or because you are restraining the person), the Public Health Agency of Canada (PHAC) recommends that a federal employee wear respiratory protection. The choice between a surgical mask and N95 respirator should be based on the following:
• Wear a surgical mask when:
- the ill person is willing and able to comply with respiratory hygiene
practices (i.e. wear a surgical mask); or
- the ill person has a weak or no cough.
• Wear a N95 respirator when
- the ill person is coughing forcefully and is unable or unwillingly to comply
with the respiratory hygiene (e.g., coughing patient who is unable or unwilling to wear a surgical mask).
The employee should also wear gloves and eye protection (e.g. goggles or safety glasses that seal to the face). Gloves and respirators/masks must be properly disposed of after use and hands should be washed again. Goggles must be disinfected after use.
At the end of the close contact, after leaving the traveler/ill person’s room, the surgical mask or N95 respirator should be removed by the straps, being careful not to touch the mask or respirator itself. The mask or respirator should be disposed of in a hands-free waste receptacle.
• Quarantine Officers called by Port of Entry Officers to assess seriously ill passengers
already screened should don their PPE before coming within two meters of the severely ill person.
• All Port of Entry Officers are advised to receive the seasonal influenza vaccine each year.
As we learn more about the situation, we will update our recommendations. Recommendations for federal employees working or traveling for work outside of Canada will be issued under a separate advisory.
The on-duty Quarantine Officer at one of the six Quarantine Stations noted below should be notified as appropriate or by calling the 24/7 PHAC Duty Officer at 1-800-545-7661. - Halifax International Airport for NS, NB, PEI, and Newfoundland/Labrador; - Montreal-Pierre Elliott Trudeau International Airport for Quebec; - Ottawa International Airport for Eastern Ontario; - Lester B. Pearson International Airport Toronto for Ontario west of Kingston and Nunavut; - Calgary International Airport for Alberta, Saskatchewan, Manitoba and NWT; and - Vancouver International Airport for BC and Yukon) Halifax International Airport 1 Bell Boulevard, Box 1624 Enfield, NS B2T 1K2 (902) 873-7659 (24 hour phone line) (902) 873-7657 (Office) (902) 872-7657 (Fax)
Office Hours: 0930 – 1730, Mon-Fri (Call 24 hour phone line in off hours) Jurisdiction: All ports in Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and Labrador Montréal - Pierre Elliott Trudeau International Airport 975 Romeo Vachon Nord Suite T.2. 127C Dorval, QC H4Y 1H1 (514) 229-2561 (24 hour phone line) (514) 633-3024 (Office) (514) 663-3031 (Fax) Office Hours: 0800 – 2400, Mon – Friday. 0900 – 1900 Weekends Jurisdiction: All ports in Quebec Ottawa International Airport 1000 Airport Parkway Room 1481 Ottawa, ON K1V 9B4 (613) 949-1565 (24 hour phone line) (613) 949-2050 (Office) (613) 949-1566 (Fax)
2009-05-08 Office Hours: 0800 - 1600, Mon-Fri (Call 24 hour phone line in off hours) Jurisdiction: All ports Eastern Ontario Lester B. Pearson International Airport (Toronto) Box 6045 Toronto, AMF, ON L5P 1B2 (416) 315-5039 (24 hour phone line) (905) 612-5397 (Office) (416) 812-5615 (Pager) (905) 612-7987 (Fax) Office Hours: 0800 - 2400, Mon-Friday. 1400 to Midnight weekends (Call 24 hour phone line in off hours) Jurisdiction: All ports in Ontario, West of Kingston and Nunavut Calgary International Airport Box 79 2000 Airport Road NE Calgary, AB T2E 6W5 (403) 221-3067 (24 hour phone line) (604) 317-1730 (QO back up line - Western Zone) (403) 221–3068 (Office) (403) 250-9271 (Fax) Office Hours: 0930 - 2130 X 7 Days/Week (Call 24 hours phone line in off hours) Jurisdiction: All ports in Alberta, Saskatchewan, Manitoba and the North West Territories Vancouver International Airport YVR Box 23671 Richmond, BC V7B 1X8 (604) 317-1720 (24 hour phone line) (604) 317-1730 (Marine, and QO Back up line - Western Zone) (604) 666-2499 (Office) (604) 666-4947 (Fax) Office Hours: 0800 - 2000 X 7 Days/Week (Call 24 hour phone line in off hours) Jurisdiction: All ports in British Columbia and the Yukon Public Health Agency of Canada Duty Officer 24/7 Line: 1-800-545-7661.

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